PERCEPTUA.ND LEXICA.ACTORS IN A CAS.F LETTER-BY-LETTER READING

Written language preservation in glioma patients undergoing awake surgery: The value of tailored intra-operative assessment

Written language is increasingly important, as contemporary society strongly relies on text-based communication. Nonetheless, in neurosurgical practice, language preservation has classically focused on spoken language. The current study aimed to evaluate the potential role of intra-operative assessments in the preservation of written language skills in glioma patients undergoing awake surgery. It is the first feasibility study to use a standardized and detailed Written language battery in glioma patients undergoing awakening surgery. Reading and spelling were assessed pre- and post-operatively in eleven patients. Intra-operatively, 7 cases underwent written language assessment in addition to spoken object naming. Results show that reading and spelling deficits may arise before and after glioma surgery and that written language may be differently affected than spoken language. In our case series, task-specific preservation of function was obtained in all cases when a specific written language skill was monitored intra-operatively. However, the benefits of intra-operative testing did not always generalize, and non-monitored written language tasks may not be preserved. Hence, when a specific written language skill needs to be preserved, to facilitate return to work and maintain quality of life, results indicate that intra-operative assessment of that skill is advised. An illustrative case report demonstrates how profile analyses can be used pre-operatively to identify cognitive components at risk and intra-operatively to preserve written language abilities in clinical practice.

Pure alexia with intact perception of complex visual stimuli: a case study

After a stroke involving the left occipitotemporal cortex our patient shows a word-length effect and has problems to identify letters or numbers in strings of symbols. But he is normal in identifying isolated letters and in non-verbally categorizing even complex images such as faces or natural scenes. His cortical lesion is stretching from the visual word form area (VWFA) anteriorly causing additional problems to name visual stimuli and to match acoustic stimuli with images. We conclude that our patient suffers from pure alexia without deficits to identify even complex visual stimuli. Our results directly contradict several explanations for letter-by-letter reading.

An eye movement study on the role of the visual field defect in pure alexia

Pure alexia is a severe impairment of word reading which is usually accompanied by a right-sided visual field defect. Patients with pure alexia exhibit better preserved writing and a considerable word length effect, claimed to result from a serial letter processing strategy. Two experiments compared the eye movements of four patients with pure alexia to controls with simulated visual field defects (sVFD) when reading single words. Besides differences in response times and differential effects of word length on word reading in both groups, fixation durations and the occurrence of a serial, letter-by-letter fixation strategy were investigated. The analyses revealed quantitative and qualitative differences between pure alexic patients and unimpaired individuals reading with sVFD. The patients with pure alexia read words slower and exhibited more fixations. The serial, letter-by-letter fixation strategy was observed only in the patients but not in the controls with sVFD. It is argued that the VFD does not cause pure alexic reading.

Prelexical representations and processes in reading: evidence from acquired dyslexia

We report a detailed and extensive single-case study of an acquired dyslexic patient, L.H.D., who suffered a left-hemisphere lesion as a result of a ruptured aneurysm. We present evidence that L.H.D.'s reading errors stem from a deficit in visual letter identification, and we use her deficit as a basis for exploring a variety of issues concerning prelexical representations and processes in reading. First, building on the work of other researchers, we present evidence that the prelexical reading system includes an allograph level of representation that represents each distinct visual shape of a letter (e.g., a, A, etc., for the letter A). We extend a theory proposed by Caramazza and Hillis [Caramazza, A., & Hillis, A. (1990a). Spatial representation of words in the brain implied by studies of a unilateral neglect patient. Nature, 346, 267-269] to include an allograph level, and we probe the nature of the allograph representations in some detail. Next, we explore the implications of visual similarity effects and letter perseverations in L.H.D.'s reading performance, arguing that these effects shed light on activation dynamics in the prelexical reading system and on the genesis of L.H.D.'s errors. We also probe the processing of letter case in the visual letter identification process, proposing that separate abstract letter identity and case representations are computed. Finally, we present evidence that the allograph level as well as the abstract letter identity level implement a word-based frame of reference.

Letter identification processes in reading: Distractor interference reveals an automatically engaged, domain-specific mechanism

Recent neuroimaging studies have revealed that letters activate both the left and the right fusiform areas, but that only the left fusiform responds to letters more than to control stimuli (Cohen et al., 2003). Though these findings suggest that the left fusiform is specialized in its function of identifying letters, it does not rule out the possibility that the right fusiform contributes critically to letter identification processes. We used a behavioural word identification task in which we compared bilateral and unilateral displays to determine the cost of engaging the right hemisphere with a distractor stimulus. We found that while engaging the left hemisphere led to a robust interference effect, engaging the right hemisphere had no effect at all. We were able to rule out an attentional bias to the right visual field as a possible explanation of the asymmetrical interference effect. We conclude that while the right hemisphere may be able to assume letter identification processing responsibilities in some patients with brain damage, the right hemisphere does not contribute critically to abstract letter identification processes in healthy right-handed individuals.

Examining the central and peripheral processes of written word production through meta-analysis

Producing written words requires “central” cognitive processes (such as orthographic long-term and working memory) as well as more peripheral processes responsible for generating the motor actions needed for producing written words in a variety of formats (handwriting, typing, etc.). In recent years, various functional neuroimaging studies have examined the neural substrates underlying the central and peripheral processes of written word production. This study provides the first quantitative meta-analysis of these studies by applying activation likelihood estimation (ALE) methods (Turkeltaub et al., 2002). For alphabet languages, we identified 11 studies (with a total of 17 experimental contrasts) that had been designed to isolate central and/or peripheral processes of word spelling (total number of participants = 146). Three ALE meta-analyses were carried out. One involved the complete set of 17 contrasts; two others were applied to subsets of contrasts to distinguish the neural substrates of central from peripheral processes. These analyses identified a network of brain regions reliably associated with the central and peripheral processes of word spelling. Among the many significant results, is the finding that the regions with the greatest correspondence across studies were in the left inferior temporal/fusiform gyri and left inferior frontal gyrus. Furthermore, although the angular gyrus (AG) has traditionally been identified as a key site within the written word production network, none of the meta-analyses found it to be a consistent site of activation, identifying instead a region just superior/medial to the left AG in the left posterior intraparietal sulcus. These meta-analyses and the discussion of results provide a valuable foundation upon which future studies that examine the neural basis of written word production can build.

Number reading in pure alexia--a review

It is commonly assumed that number reading can be intact in patients with pure alexia, and that this dissociation between letter/word recognition and number reading strongly constrains theories of visual word processing. A truly selective deficit in letter/word processing would strongly support the hypothesis that there is a specialized system or area dedicated to the processing of written words. To date, however, there has not been a systematic review of studies investigating number reading in pure alexia and so the status of this assumed dissociation is unclear. We review the literature on pure alexia from 1892 to 2010, and find no well-documented classical dissociation between intact number reading and impaired letter identification in a patient with pure alexia. A few studies report strong dissociations, with number reading less impaired than letter reading, but when we apply rigorous statistical criteria to evaluate these dissociations, the difference in performance across domains is not statistically significant. There is a trend in many cases of pure alexia, however, for number reading to be less affected than letter identification and word reading. We shed new light on this asymmetry by showing that, under conditions of brief exposure, normal participants are also better at identifying digits than letters. We suggest that the difference observed in some pure alexic patients may possibly reflect an amplification of this normal difference in the processing of letters and digits, and we relate this asymmetry to intrinsic differences between the two types of symbols.

A combined fMRI study of typed spelling and reading

In this study we employed a novel technique to examine the neural basis of written spelling by having subjects touch-type single words on an fMRI compatible QWERTY keyboard. Additionally, in the same group of participants we determined if task-related signal changes associated with typed spelling were also co-localized with or separate from those for reading. Of particular interest were the left inferior frontal gyrus, left inferior parietal lobe as well as an area in the left occipitotemporal cortex termed the Visual Word Form Area (VWFA), each of which have been associated with both spelling and reading. Our results revealed that typed spelling was associated with a left hemisphere network of regions which included the inferior frontal gyrus, intraparietal sulcus, inferior temporal/fusiform gyrus, as well as a region in the superior/middle frontal gyrus, near Exner's area. A conjunction analysis of activation associated with spelling and reading revealed a significant overlap in the left inferior frontal gyrus and occipitotemporal cortex. Interestingly, within the occipitotemporal cortex just lateral and superior to the VWFA we identified an area that was selectively associated with spelling, as revealed by a direct comparison of the two tasks. These results demonstrate that typed spelling activates a predominantly left hemisphere network, a subset of which is functionally relevant to both spelling and reading. Further analysis revealed that the left occipitotemporal cortex contains regions with both conjoint and dissociable patterns of activation for spelling and reading.

Visuoperceptual deficits in letter-by-letter reading?

A longstanding and controversial issue concerns the underlying mechanisms that give rise to letter-by-letter (LBL) reading: while some researchers propose a prelexical, perceptual basis for the disorder, others postulate a postlexical, linguistic source for the problem. To examine the nature of the deficit underlying LBL reading, in three experiments, we compare the performance of seven LBL readers, matched control participants and one brain-damaged patient, OL, with no reading impairment. Experiment 1 revealed that the LBL patients were impaired, relative to the controls and to OL, on a same/different matching task using checkerboards of black and white squares. Given that the perceptual impairment extends beyond abnormalities with alphanumeric stimuli, the findings are suggestive of a more general visual processing deficit. This interpretation was confirmed in Experiments 2 (matching words and symbol strings) and 3 (visual search of letter and symbol targets), which compared the processing of linguistic and non-linguistic written stimuli, matched for visual complexity. In both experiments, the LBL patients displayed qualitatively similar effects of length and left-to-right sequential ordering on linguistic and non-linguistic stimuli. Moreover, there was a clear association between the perceptual impairments on these tasks and the slope of the reading latency function for the LBL patients. Taken together, these findings are consistent with a significant visuoperceptual impairment in LBL that adversely affects reading performance as well as performance on other non-reading tasks.

Neural regions essential for reading and spelling of words and pseudowords

OBJECTIVE

To identify dysfunctional brain regions critical for impaired reading/spelling of words/pseudowords by evaluating acute stroke patients on lexical tests and magnetic resonance imaging, before recovery or reorganization of structure-function relationships.

METHODS

A series of 106 consenting patients were administered oral reading and spelling tests within 24 hours of left supratentorial stroke onset. Patients underwent diffusion- and perfusion-weighted magnetic resonance examination the same day to identify regions of hypoperfusion/infarct of 16 Brodmann areas.

RESULTS

Simultaneous logistic regression analysis demonstrated that dysfunction of left Brodmann areas 40 (supramarginal gyrus) and 37 (posterior-inferior temporal/fusiform gyrus) best predicted impairment in reading words (odds ratio [OR], 6.20 [95% confidence interval (CI), 1.54-24.96] and 2.71 [95% CI, 0.87-8.45], respectively), reading pseudowords (OR, 39.65 [95% CI 3.9-400.78] and 4.41 [95% CI, 1.1-17.51], respectively), spelling words (OR, 14.11 [95% CI 1.37-144.93] and 7.41 [95% CI, 1.48-37.24], respectively), and spelling pseudowords (OR, 4.84 [95% CI, 0.73-32.13] and 7.74 [95% CI, 1.56-38.51], respectively). Whole-brain voxel-wise analyses demonstrated voxel clusters within these regions that were most strongly associated with task deficits.

INTERPRETATION

Results indicate that a shared network of regions including parts of left Brodmann areas 37 and 40 is necessary for reading and spelling of words and pseudowords. Further studies may define the precise roles of these brain regions in language. Identification of any neural regions specific to one of these tasks or one type of stimuli will require study of more patients with selective deficits.

Top-down and bottom-up effects in pure alexia: evidence from eye movements

The eye movements of a patient with pure alexia, GJ, were recorded as he read sentences in order to explore the roles of top-down and bottom-up information during letter-by-letter reading. Specifically, the effects of word frequency and word predictability were examined. Additional analyses examined the interaction of these effects with the lower level influences of word length and letter confusability. The results indicate that GJ is sensitive to all four of these variables in sentence reading. These findings support an interactive account of reading where letter-by-letter readers use both bottom-up and top-down information to decode words. Due to the disrupted bottom-up processes caused by damage to the Visual Word Form Area or the input connections to it, pure alexic patients rely more heavily on intact top-down information in reading.

Cognitive and neural mechanisms underlying reading and naming: evidence from letter-by-letter reading and optic aphasia

We report detailed analysis of language performance in a patient, RMI, a 55-year-old man who presented with a homonymous hemianopsia, optic aphasia, and alexia without agraphia (with letter-by-letter reading) acutely after stroke. MRI showed infarct in the left occipital and medial temporal lobe and hypoperfusion of the entire posterior cerebral artery territory, including the splenium. Extensive language testing revealed severely impaired picture naming and oral reading, with relatively spared tactile naming and recognition of orally spelled words, consistent with impaired access to lexical and semantic representations from vision. In addition, he had a milder deficit in accessing lexical representations for output from all input modalities. RMI's execution of various language tasks provided considerable insight into the mechanisms that underlie oral reading. His performance indicated that both semantic access and orthographic to phonologic conversion mechanisms were partially intact. When information from these two impoverished systems was coupled (the picture of an object presented with its written name), his ability to read/name improved significantly, consistent with the hypothesis that partially accessed semantic information from vision can combine with partially accessed sublexical orthographic to phonologic conversion mechanisms to access phonological representations for output. Furthermore, his written word and picture recognition improved to normal at a time when magnetic resonance perfusion imaging demonstrated reperfusion of the splenium. We interpret these results, as well as results from previous studies in the literature, within a model of the neural regions critical for various cognitive processes underlying reading.

DTI tractography based parcellation of white matter: application to the mid-sagittal morphology of corpus callosum

Morphology of the corpus callosum (CC) at the mid-sagittal level has been a target of extensive studies. However, the lack of internal structures and its polymorphism make it a challenging task to quantitatively analyze shape differences among subjects. In this paper, diffusion tensor Imaging (DTI) and tract tracing technique were applied to incorporate cortical connectivity information to the morphological study. The CC was parcellated into six major subdivisions based on trajectories to different cortical areas. This subdivision was performed for eight normal subjects and one stroke patient. The parcellated CCs of the normal subjects were normalized for morphological analysis. When comparing the stroke patient to the normal population, we detected significant atrophy in the motor and sensory areas of the patient CC, in line with the clinical deficits. This approach provides a new tool to investigate callosal morphology and functional relationships.

Are there lexicons?

Many models of the processing of printed or spoken words or objects or faces propose that systems of local representations of the forms of such stimuli--lexicons--exist. This is denied by partisans of the distributed-representation connectionist approach to cognitive modelling. An experimental paradigm of key theoretical importance here is lexical decision and its analogue in the domain of objects, object decision. How does each theoretical camp account for our ability to perform these two tasks? The localists say that the tasks are done by matching or failing to match a stimulus to a local representation in a lexicon. Advocates of distributed representations often do not seek to explain these two tasks; however, when they do, they propose that patterns of activation evoked in a semantic system can be used to discriminate between words and nonwords, or between real objects and false objects. Therefore the distributed-representation account of lexical and object decision tasks predicts that performance on these tasks can never be normal in patients with an impaired semantic system, nor in patients who cannot access semantics normally from the stimulus domain being tested. However, numerous such patients have been reported in the literature, indicating that semantic access is not needed for normal performance on these tasks. Such results support the localist form of modelling rather than the distributed-representation approach.

The roles of the “visual word form area” in reading

Activation of the left midfusiform gyrus in response to reading words and pseudowords is such a reliable finding in functional imaging that this region has been called "the visual word form area" (VWFA). However, this label has recently been challenged, because activation in VWFA is also observed in other lexical tasks. We evaluated whether VWFA is necessary, sufficient, or specialized for reading by examining how frequently acute lesions in VWFA disrupt tasks that require access to written word forms versus other lexical tasks. We administered lexical tasks with spoken and written input and output, and identified damage or dysfunction of VWFA and other regions of interest (ROI) on diffusion- and perfusion-weighted imaging (DWI and PWI) in 80 patients within 24 h of onset of acute left ischemic stroke. Associations between abnormalities in each region of interest and impairment on lexical tasks were evaluated with chi-squared tests. Damage or dysfunction of VWFA was not significantly associated with impairment of written word comprehension or lexical decision, but was significantly associated with impairment on all tasks requiring lexical output: oral reading and oral naming (visual or tactile input), and written naming. We account for these results and results from functional imaging by proposing that the left midfusiform gyrus normally has two roles in reading: (1) computation of location- and modality-independent grapheme sequences from written word stimuli, and (2) a modality-independent stage of lexical processing that links modality-specific input and output representations. VWFA is not necessary for the former because the right homologue of VWFA can immediately assume this role.

The eye movements of Japanese pure alexic patients during single word and nonword reading

Two Japanese patients with pure alexia, SH and YH, who showed right homonymous hemianopia following a left occipital lobe lesion, demonstrated letter-by-letter (LBL) reading in pronouncing Japanese kana words and nonwords. In contrast to alphabetic letters, each Japanese kana character has an invariant and identical pronunciation whether it appears in isolation or as a component of any word and nonword string. It is important to investigate the eye movements as well as reading latency and duration in Japanese-speaking LBL readers. Relative to normal controls, these patients demonstrated a more robust string-length effect, which was characterized by larger increases in reading latency and duration as well as in the number of fixations as the string length increased. We propose that in pure alexia, parallel activation of orthographic representations is abnormally delayed but not completely abolished.

Pre-frontal executive committee for perception, working memory, attention, long-term memory, motor control, and thinking: a tutorial review

As an explicit organizing metaphor, memory aid, and conceptual framework, the prefrontal cortex may be viewed as a five-member 'Executive Committee,' as the prefrontal-control extensions of five sub-and-posterior-cortical systems: (1) the 'Perceiver' (dominant-right-hemisphere ventral-lateral prefrontal cortex--VL/PERC-PFC) is the frontal extension of the ventral perceptual stream (the VL/PERC system) which represents the world and self in object coordinates; (2) the 'Verbalizer' (dominant-left-hemisphere ventral-lateral prefrontal cortex system--VL/VERB-PFC) is the frontal extension of the language stream (the VL/VERB system) which represents the world and self in language coordinates; (3) the 'Motivator' (ventral/medial-orbital pre-frontal cortex--VMO-PFC) is the frontal cortical extension of a subcortical extended-amygdala stream (the VMO system) which represents the world and self in motivational/emotional coordinates; (4) the 'Attender' (dorsal-medial/anterior cingulate--DM/AC-PFC) is the frontal cortical extension of a subcortical extended-hippocampal stream (the DM/AC system) which represents the world and self in spatiotemporal coordinates and directs attention to internal and external events; and (5) the 'Coordinator' (the dorsolateral prefrontal cortex--DL-PFC) is the frontal extension of the dorsal perceptual stream (the DL system) which represents the world and self in body- and eye-coordinates and controls willed action and working memory. This tutorial review examines the interacting roles of these five systems in perception, working memory, attention, long-term memory, motor control, and thinking.

The eye movements of pure alexic patients during reading and nonreading tasks

We compared the eye-movements of two patients who read letter-by-letter (LBL) following a left occipital lobe lesion with those of normal control subjects and of hemianopic patients in two tasks: a nonreading visual search task and a text reading task. Whereas the LBL readers exhibited similar eye-movement patterns to those of the other two groups on the nonreading task, their eye movements differed significantly during reading, as reflected in the disproportionate increase in the number and duration of fixations per word and in the regressive saccades per word. Importantly, relative to the two control groups, letter-by-letter readers also made more fixations per word as word length increased, especially as word frequency and word imageability decreased. Two critical results emerged from these experiments: First, the alteration in the oculomotor behavior of the LBL readers during reading is similar to that seen in normal readers under difficult reading conditions, as well as in beginning readers and in those with developmental dyslexia, and appears to reflect difficulties in processing the visual stimulus. Second, the interaction of length with frequency and with imageability in determining the eye movement pattern is consistent with an interactive activation model of normal word recognition in which weakened activation of orthographic input can nevertheless engage high-level lexical factors.

Does dyslexia develop from learning the alphabet in the wrong hemisphere? A cognitive neuroscience analysis

A new perspective is described which views developmental dyslexia as the outcome of learning to write the alphabet in the nondominant (right) hemisphere. The letter-level and whole-word subtypes of dyslexia are seen as differing responses adopted to cope with this predicament. Striking similarities between dyslexics and callosotomy patients in the allocation of covert attention to lateralized stimuli provide direction for integrating a diversity of dyslexic research within this framework. This synthesis, together with information from pure alexia, brain activation, and reading research, lends insight into the neural circuitry of the compensatory strategies adopted by the two dyslexic subtypes.

Modularity and cognition

Modularity is a concept central to cognitive science, and Fodor's analysis of cognitive modularity in his book The Modularity Of Mind has been widely influential - but also widely misunderstood. It is often claimed that the possession of some or other system-property is a necessary condition for that system to be modular in Fodor's sense, but Fodor made it clear that he was not proposing a definition of modularity, nor proposing any necessary conditions for the applicability of the term. He was simply suggesting a number of system properties that are typical of modular systems. I argue that it is nevertheless possible to derive a useful definition of modularity from the kinds of arguments put forward by Fodor: A cognitive system is modular when and only when it is domain-specific. Given any such proposed module, the other features of modularity discussed by Fodor should be dealt with as empirical issues: for each feature (innateness, for example), it is an empirical question whether or not the proposed module has that feature.